The Paediatrics And Geriatrics Discussion

Dosing medications for children and seniors require special considerations to ensure that they do not suffer from the toxic effects of the drugs due to poor absorption and metabolism. When calculating the dosages of this group, it is essential to consider the functioning of the hepatic and renal systems since this is where most drugs’ metabolism and excretion occur (DeRhodes, 2019)The Paediatrics And Geriatrics Discussion. As a result, these groups should be given lower doses of drugs. For children, dosages should be calculated based on their weight to avoid issues arising from under or overdosing.

ORDER HERE A PLAGIARISM-FREE PAPER 

The beer’s criteria contain guidelines that healthcare professionals can use to improve the safety of prescribing medications among older adults 65 years old and above, apart from those in palliative settings. It also provides criteria for prescribing medications to individuals with high severity concerns (DeRhodes, 2019).

When analyzing the presented scenario, the possible diagnosis for Brian Is attention deficit hyperactivity disorder (ADHD). ADHD affects a large section of children and is mainly characterized by hyperactivity, inattention, and impulsivity, making it difficult for one to concentrate on their routine activities or pay attention to a specific task (Sayal et al., 2018). Brian’s case is not different since he has all these cardinal signs. One of the possible differential diagnoses is bipolar disorder. Doctors experience difficulties differentiating between ADHD and bipolar disorders since they manifest similarly, including mood changes, outbursts, impatience, restlessness, and talkativeness. However, paying attention to the manifestation of each condition may help one narrow down to one definite diagnosis (Sayal et al., 2018)The Paediatrics And Geriatrics Discussion. For instance, the main manifestations of ADHD include inattention, distractibility, and impulsivity.

Asking the right questions is key to narrowing down to a definite diagnosis. In this case, asking whether the child had other health conditions such as sleep apnea is vital. Children suffering from sleep apnea exhibit signs of ADHD; hence, asking this question may help determine other health conditions’ existence.

Although different medications can be used to manage ADHD, the most appropriate recommendation for this case is Methylphenidate. The rationale for selecting this medication is that it has proven to have a favorable impact in lowering the core symptoms of excessive hyperactivity, impulsivity, and inattention in children; hence should be considered for use (Huss et al., 2017). Some of the possible side effects include nausea, vomiting, anorexia, headache, and insomnia. These side effects are, however, self-limiting and will go away within a few days (Huss et al., 2017).

No laboratory-based medical tests can help confirm an ADHD diagnosis; however, conducting liver function tests and electrolyte level tests may aid in diagnosis and treatment. Different rating scales are available for use and have proven to be effective in diagnosing ADHD (Wolraich et al., 2019) The Conner’s comprehensive Behavior scale (CBRS) and the Vanderbilt scales provide valuable insights into the presence of core symptoms of ADHD as outlined in the Diagnostic and Statistical Manual (DSM-5). Enrolling a child with ADHD in a support group can prove valuable since it gives them a foundation to interact and learn from their peers with similar problems (Wolraich et al., 2019)The Paediatrics And Geriatrics Discussion. As a result, Brian should be enrolled in a social group that will help him in learning how to improve his attention and interaction with others.

ORDER HERE

References.

DeRhodes, K. H. (2019). The dangers of ignoring the beers Criteria: The prescribing cascade. JAMA Internal Medicine, 179(7), 863-864.

Huss, M., Duhan, P., Gandhi, P., Chen, C. W., Spannhuth, C., & Kumar, V. (2017). Methylphenidate dose optimization for ADHD treatment: Review of safety, efficacy, and clinical necessity. Neuropsychiatric disease and treatment.

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186.

Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., & Hagan, J. F. (2019). ADHD diagnosis and treatment guidelines: a historical perspective. Pediatrics, 144(4).

Discussion –Special Populations: Pediatrics and Geriatrics

What additional considerations should be given when dosing medications for children and seniors and why? 

What is the Beers Criteria?

Any differential diagnoses

Your diagnosis and reasoning

Any additional questions you would have asked

Medication recommendations along with your rationale. Note possible side effects or issues  to address if attempting to obtain consent.

Any labs and why they may be indicated

Screener scales or diagnostic tools that may be beneficial

Additional resources to give  (Therapy modalities, support groups, activities, etc.)The Paediatrics And Geriatrics Discussion.

CASE STUDY

Brian, a 9 yr old who presents with his mother to the psychiatric nurse
practitioner’s office for an initial evaluation, seems of normal height and
weight. His mother explains that they came in at the father’s insistence
that Brian be evaluated for ADHD. He has never been to a mental health
office before, and has never taken medication for mood, behaviour or
ADHD. Brian’s parents have been divorced for 1½ yrs, and have shared
custody of him and his 7 yr old sister Emily. The shared custody
agreement is on file in Brian’s chart. The children spend alternating
weeks with their father and stepmother, and with their mother.
Brian’s mother describes his behaviour as normally active for a boy his
age. He’s always had a lot of energy. He makes A’s, B’s and C’s in school,
and his current 4th grade teacher has expressed concern about his
hyperactivity and inattention; last year’s teacher never mentioned it. He
seems to be having a little more trouble this year keeping up with
assignments. Mom reports that she sits with Brian while he does
homework to help him stay on task. She reports that Brian met all
developmental milestones, has no medical problems, and has never
repeated a grade. He has been sent to the principal’s office 3 times this
year for excessive talking in class. He does require several reminders at
night to go to bed and to stay in bed. He likes to “do one more thing”.
His room has always been messy, as has his sister’s. Mom denies that he
has any unusual behaviour problems. He enjoys all sports but is not on
any teams. He can play a video game for over 2 hours at a time, but
doesn’t seem to watch TV for more than 15-20 minutes without wanting
to do something else. He quarrels with his younger sister, but Mom
doesn’t think this is out of the ordinary for siblings. When asked why
Dad believes Brian may have ADHD, Mom reports that Dad complains of
Brian not listening, not following instructions and not being able to sit at
the table and complete his homework. Mom attributes the increased
difficulty in school this year and any behaviour problems at Dad’s house
to difficulty adapting to the divorce, and to his new step-mother of 4
months. Mom reports that Brian has complained of the step-mother
being too harsh, and not feeling comfortable during his weeks with Dad.
Brian has been fidgeting through most of this discussion, but has
remained in his seat next to Mom. He rarely interjects any comments.
When asked directly about the situation, he mumbles some answers,
making little eye contact. He becomes more interactive describing his
favourite video game, and listing the friends he plays basketball with at
both houses. There is a basketball hoop in both driveways The Paediatrics And Geriatrics Discussion. He is

reluctant to discuss conditions at Dad’s house, or his relationship with
his father or step-mother. He seems to have an appropriate vocabulary
for his age. The Paediatrics And Geriatrics Discussion
When the nurse practitioner later calls Dad for more information, he is
quite vocal about Brian’s difficulties at his house. Brian doesn’t seem to
listen, he forgets to follow through with tasks, even within a span of 3
minutes. Brian’s step-mother does supervise homework, and is
frustrated that one math work sheet can take over an hour because
Brian loses focus and starts doing other things. He cannot seem to resist
arguing with his sister, and has to be reminded repeatedly not to talk
back or argue with the adults. Emily is much easier to handle and seems
to enjoy spending time with their step-mother. He reports that they use
time out and restriction of privileges for punishment of bad behaviour,
and these seem to work, but Brian seems to soon impulsively repeat the
offending behaviours again without seeming to have learned anything.
Dad has talked with Brian’s teacher and she reports frequent talking in
class, blurting out answers when it’s not his turn, and difficulty staying in
his seat. She has arranged the room so Brian is directly in front of her desk,
but he is still easily distracted. Dad suspects that Mom helps Brian so much
that she doesn’t even notice that he has more difficulty than other boys his
age. Dad would like to get Brian into a community basketball league, but
he’s not sure he could concentrate and follow instructions. The step-
mother wants him to be more caught up in school and better behaved at  home before he joins a team.

ORDER NOW

Include:
Any differential diagnoses
Your diagnosis and reasoning
Any additional questions you would have asked
Medication recommendations along with your rationale. Note possible side
effects or issues to address if attempting to obtain consent.
Any labs and why they may be indicated
Screener scales or diagnostic tools that may beneficial Additional resources to give (Therapy modalities, support groups, activities, etc.) The Paediatrics And Geriatrics Discussion